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ECONOMICS, EDUCATION, AND POLICY

A Psychological Basis for Anesthesiologists’ Operating Room Managerial Decision-Making on the Day of Surgery

Franklin Dexter, MD, PhD^*, John D. Lee, PhD, Angella J. Dow, BS, and David A. Lubarsky, MD, MBA

From the *Departments of Anesthesia and Health Management and Policy, Division of Management Consulting; Department of Mechanical and Industrial Engineering; Department of Anesthesia, University of Iowa, Iowa; and Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Florida.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Department of Anesthesia and Health Management and Policy, Division of Management Consulting, University of Iowa, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu or www.FranklinDexter.net.

Abstract

BACKGROUND: We investigated whether, without prompting, anesthesiologists tend to make managerial decisions to increase the clinical work per unit time of the sites to which they are assigned during their scheduled time present. Although a sound basis for decision-making involving individual ORs, the heuristic is often suboptimal economically when applied to decisions involving multiple ORs.

METHODS: Two studies were performed at one hospital. 1) A retrospective analysis was made of anesthesiologists’ managerial decisions when caring for sequential lists of patients. 2) Patients’ and surgeons’ waiting on nights and weekends were studied before/after education on optimal decision-making.

RESULTS: 1) Anesthesiologists’ decisions resulted in an increase in their clinical work per unit time, not a reduction in patient waiting. 2) Paradoxically, such efforts on nights and weekends caused increased patient and surgeon waiting. Decisions were unchanged after education on a different way to assign cases.

CONCLUSIONS: In a companion article, we showed that clinicians tended to make decisions that increased the clinical work per unit time at each moment in each OR, even when doing so resulted in an increase in overutilized OR time, higher staffing costs, unpredictable work hours, and/or mandatory overtime. The current studies show that such efforts to work fast cannot be explained as a consequence of efforts to reduce surgeon and patient waiting. Rather, the heuristic followed is consistent with increasing one’s personal clinical work per unit time at one’s assigned anesthetizing location.

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